As America begins to put the COVID-19 pandemic in the rearview, the lesson from this once-in-a-generation crisis couldn’t be clearer: We need less, not more, central planning in our lives.
For example, a study earlier this year by health economist Casey Mulligan revealed that economic lockdowns mandated by government were counterproductive, given the significant steps workplaces took to prevent the virus from spreading.
The same is true with health care. By now, most folks know the story of how Operation Warp Speed — the previous administration’s unprecedented plan to trim bureaucracy from the vaccine development process — resulted in the creation of multiple safe and effective vaccines in record time. But an equally important storyline is how states took a sledgehammer to their own bureaucracies to expand access to care for those in need.
Thirty-eight states increased the availably of telehealth in response to the pandemic. Another 24 states waived certificate-of-need laws, which require hospitals to receive a permission slip from the government before they can open or add new facilities.
COVID-19 is forcing a long-overdue transformation of how health care is delivered in our country. As University of Michigan professor Rashid Bashur recently put it, “the genie’s out of the bottle.”
And yet, President Joe Biden, House Speaker Nancy Pelosi, and others in Congress are remarkably missing this point. Even though their big government approach to health care hasn’t increased access to affordable care, they claim the solution is to double down on this failed path. The far left is pushing Biden to adopt even more radical ideas, like putting government in complete control of health care.
Instead of an even more centralized system, let’s give voters what they deserve — a personal option that keeps what they like about their health care, fixes what they don’t like, and puts people, not bureaucrats, in control of their care.
One important improvement would be to expand tax-free health savings accounts. HSAs save people at least 15 percent each time they make a health care purchase. Yet, given the current constraints, only one in 10 Americans are eligible for an HSA at any given time. By expanding eligibility, more Americans would be able to save for health care costs. For those with less income, Congress could directly fund their accounts.
There is strong bipartisan support for expanding the use of telehealth, which has the ability to level the playing field in terms of location and access. While it has seen an uptick during the COVID-19 pandemic, this technology is still not available to all, especially in underserved rural and urban communities. There is bipartisan support for giving more Americans access to virtual care. Lawmakers should waste no time getting it done.
While short-term coverage is, by definition, not a long-term solution, it is a viable option for people and families, especially when the policy holder is between jobs. In some states, short-term plans cost up to 80 percent less than traditional health insurance plans. While opponents feared short-term plans would drive up prices on the ACA exchanges, the only states where premiums have gone up are in the five that prohibit short-term plans.
For far too long, the Food and Drug Administration has taken its time in approving drugs and medical devices that were approved in other advanced countries, such as Japan and in the EU. In addition, the FDA won’t allow the sharing of valid scientific information about promising experimental or “off-label” uses of already approved drugs and devices. Changing these processes could save many lives and result in cost savings.
All of this builds on reforms proposed last year in Healthcare For You, and these ideas resonate strongly with Americans. A recent poll by Public Option Strategies shows that voters prefer a personal option to the “public option” or “Medicare for All” by nearly 40 points. Among independents, the poll found that a personal option outperformed “Medicare for All” by 60 points and the “public option” by more than 35 points
The point is, there are smarter, more effective, and more popular ways to reduce costs and give people more options than simply expanding government’s grip over the system.
For years, opponents of government-run health care have made this argument but haven’t sold the public on a compelling enough alternative. That alternative has arrived.
It’s time to deliver a health care system that works for everyone. It’s time for a personal option.
The rapid spread of the COVID-19 delta variant has spooked people who thought the pandemic had ended. Policymakers have called the rise in new infections associated with the strain first encountered in India alarming even though the data suggest strongly the latest variant strain, while perhaps easier to contract, is far less lethal than the original.
Like the disease for which it is named, America’s COVID crisis continues to evolve. The end of the lockdowns in most states has people back to work, unmasked, and happy – even as some public health professionals are urging a renewed mandate to put them back on. All that, combined with the lack of clarity coming from groups like the National Education Association and American Federation of Teachers means that no parent can be sure the schools run by the government will offer full-time, in-class instruction when and if they reopen in the fall.
All this could have been avoided if the rush to lockdowns had been slowed and while greater thought was given to a plan to segregate out and protect the most vulnerable populations which, it has been lost on some people, does not include K thru 12 school-age children. Given the difference in approach to containing COVID taken by the governors of red states compared to those who lead blue states, it is not surprising to learn Democrats are hoping that masks and vaccines not yet approved for children under the age of 18 will be mandated before schools are allowed to return to pre-COVID instruction.
According to a recent survey by Rasmussen reports, just over a third of all Americans said they believed children should have to be vaccinated for COVID before they can return to the classroom. Of those, more than half – 56 percent – were Democrats. Only 29 percent of Republicans agreed.
The data, Rasmussen reports said, showed a “strong correlation” between support for masking children and for forcing them to be vaccinated. “Among Americans who think schools should require children to wear masks to protect against the coronavirus, 68 percent also think schools should require children to get the COVID-19 vaccine. Among those who oppose schools requiring children to wear masks, 79 percent are also against schools requiring children to get the coronavirus vaccination.”
The split along party lines on the issues is clear. Majorities of Republicans (61 percent) and independents (52 percent) said they opposed a vaccine requirement. Likewise, on the issue of masks, 58 percent of Democrats said they thought masks should be required as part of the basic back-to-school outfit while only 27 percent of Republicans thought this would be a good idea. Almost two-thirds of GOPers – 60 percent – and as well as a plurality of independents, the polling firm reported, said they were opposed to the mandatory classroom masking in K thru 12 classrooms.
The pollster found white Americans “slightly more in favor of schools requiring children to get the COVID-19 vaccine than blacks or other minorities” while blacks were “more supportive” than whites or other minorities regarding a requirement children wear masks. And that upper-income Americans were more in favor of requiring children to get vaccinated, with 48 percent of those earning $200,000 a year or more “favoring mandatory vaccination” while just 36 percent of those earning less than $30,000 a year agreed.The survey of 1,000 U.S. American Adults was conducted on July 13-14, 2021. The margin of sampling error is +/- 3 percentage points with a 95 percent level of confidence.
Dr. Anthony Fauci has become increasingly defensive and evasive in answering legitimate questions posed by members of Congress.
This is a problem.
Fauci has no statutory authority to preside over a public health crisis. Nonetheless, he has become the nation’s de facto doctor in chief during the COVID-19 pandemic. He clearly relishes the attention — making an astronomical number of media appearances that promote himself, but not public health. Unfortunately, Fauci has been a horribly ineffective doctor in chief.
Fauci started off the pandemic by telling us that “people should not be walking around with masks.” This initial dismissal of masks was fact-based and rational. But now, Fauci advocates wearing two masks even after vaccination. Where are the reliable scientific studies proving that masks save lives? Or that they are necessary after vaccination?
The idea that those who’ve been vaccinated or have natural immunity should still wear masks for the next year or two on a seasonal basis is one of the most insanely idiotic and anti-science statements made since some worry-warts on Christopher Columbus’s crew expressed concerns that they might sail off the edge of the Earth.
I’d like to hear Fauci explain what he has been doing for the last 50 years to avoid contracting or spreading the deadly smallpox virus or polio. Answer: He’s done nothing because vaccines work.
But Fauci advocates people get vaccinated while also suggesting that it won’t actually help. We still can’t return to normal life, he says. It is little wonder that many question why they should get vaccinated. It is the logical result of Fauci’s anti-science approach!
Here’s the truth — Fauci isn’t a serious doctor or a serious scientist. He’s just a serious government bureaucrat who happens to have a medical degree and often wears a white lab coat.
However, Sen. Rand Paul is a real medical doctor. Even as a senator, he performs eye surgeries for at-need patients around the globe. Paul has asked some very good questions of Fauci. But it is Fauci who sounds like the consummate politician with his bureaucratic two-step of word games and obfuscation. His answers have often been dismissive, combative, and evasive. He defiantly tells Paul he’s wrong but doesn’t bother to explain why. We are simply supposed to take his word for it. That’s not very scientific.
Consider what happened this week when Paul asked Fauci about U.S. government direct and indirect grants (via third party Eco-Health Alliance) to the Wuhan Institute of Virology. Since the Wuhan lab may have been where the virus escaped from, taxpayer funding of the lab is an important question. Yet, Fauci flatly denied funding any Chinese “gain-of-function research” — a risky and controversial approach that involves making pathogens more infectious and deadly. But Fauci also admitted he funded “gain-of-function research” in the United States. He also admitted he couldn’t account for how the Chinese used U.S. taxpayer dollars.
If Fauci doesn’t know how the WIV spent U.S. money, he cannot categorically deny that this money was used to fund risky research.
We can draw a lot of conclusions from the way the totalitarian Chinese regime has blocked and interfered with investigations into the origins of this pandemic. That is precisely how the guilty behave. Likewise, Fauci’s answers to Paul give rational people good reason to question his credibility. If Fauci wants to be taken seriously as a doctor and scientist, he should act like a doctor and scientist rather than a politically motivated bureaucrat.
The hack that shut down the Colonial Pipeline has most Americans worried about threats to the nation’s computer network. According to a recent surveyby Rasmussen Reports, 85 percent of Americans are at least “somewhat concerned” about the safety of the nation’s computer infrastructure.
Their concerns are not idle ones—they exist across vital sectors of the economy. Over the last decade, the health care industry has become increasingly vulnerable to ransomware attacks like the one we’ve just been through in the energy sector. Experts have been raising the alarm but thus far their warning cries have not received the attention they deserve.
That needs to change. Policymakers need to pay attention as these kinds of attacks become more frequent and more expensive. According to a study conducted by Comparitech, in 2020 alone 92 individual ransomware attacks occurred that cost an estimated $20 billion and affected over 600 separate clinics, hospitals and organizations and more than 18 million patient records.
Health care systems rely more and more on devices that use network-integrated software components. These machines—MRI machines, CT scanners and the like—are a vital part of 21st century health care. We cannot do without them so we must take steps to ensure they cannot be hacked. Unfortunately, despite growing vulnerabilities, hospitals and other providers are allowing cost concerns to create a serious security gap that could further jeopardize the integrity of certain medical devices, as well as health systems more broadly: third-party medical device servicing activities.
Online infrastructure must be protected from hackers who can cause life-saving technologies to crash with the push of a button. These technologies are essential to diagnostic and therapeutic services and for patient care. People literally cannot live without them yet it’s not clear they are being protected, especially when they need to be repaired. Problematically, these vulnerabilities are being studied just as intently by manufacturers and operators as they are by America’s enemies.
By way of example of how wide the problem may stretch, in contrast to repairs undertaken by the original manufacturers of the equipment, who are heavily regulated by the U.S. Food and Drug Administration and who operate within what are called “mandatory quality system requirements,” independent firms who compete in the same space at lower cost are generally allowed to operate without supervision. There are no applicable industry standards against which their work can be measured—yet their ability to do the same work cheaper makes them attractive to institutions like hospitals and clinics where cost is a primary concern.
The practical implications of this should be obvious. In an interconnected health care ecosystem which the United States has, devices and systems are constantly updating, requiring everyone from manufacturers to hospitals, doctors and clinics to those who maintain and service highly technical, life-saving devices to do their part to keep systems safe. There’s been some regulatory process recently that’s made things safer, but the job is not yet done.
Imagine if a foreign intelligence service stood up a company to repair medical devices or debug health care software for some of the nation’s biggest hospital systems. In that circumstance, the potential for chaos, even death, exists as does the chance private medical information of untold numbers of Americans could be compromised. Significant issues still exist where medical device servicing and aftermarket repairs are concerned. If an independent operator separate from the original manufacturer of a critical piece of interconnected medical hardware even inadvertently opened a backdoor to a threat by bungling a repair job or using a few unauthorized lines of code, the damage could be severe. No one likes the heavy hand of regulation, but in the interests of safety, some minimum standards are needed.
This is the kind of small issue that, when compared to his multibillion-dollar infrastructure plan, President Joe Biden could push for a solution in a bipartisan manner. He’s already issued an executive order on cybersecurity, but he needs to do more as does Congress. A thorough review of important systems that can be hacked, taken offline, or held for ransom is long overdue.
The danger is real, and the American people understand it, especially after everything we’ve been through during the pandemic. We know Russia, China, Iran and others are trying to hack our critical systems, and in a few cases, succeeded. This is a problem too important to ignore and Republicans and Democrats should come together to deal with it before it becomes a problem we can’t live with.
Keep the STOP Act to halt the Opioid Epidemic
The Synthetics Trafficking and Overdose Prevention Act, more commonly known as the STOP Act is a bipartisan bill, that was signed into law in October 2018 in order to reduce the amount of illicit items traveling through the U.S. Postal Service in the United States. This law was specifically designed to help close an existing loophole that has allowed illicit drugs, which have contributed to the nation’s opioid crisis, to be transported into the United States via USPS.
Unfortunately, the forces in Washington, DC are considering measures that would effectively pause the progress in compliance, or adjust the compliance thresholds of this law, either of which would negatively affect the identification and prevention of the spread of illicit and illegal distributions.
The Postal Service Should Do What Other Shippers Do to Reduce Illegal Drug Shipments
The STOP Act requires the USPS to gather advance electronic data (AED) for inbound international packages. It requires foreign postal operators to include fields such as the item identifier, sender’s full name and address, recipient’s full name and address, stated content description, unit of measure and quantity, weight, declared value, and date of mailing. With the tightened security, it helps reduce the number of bad actors who use the USPS loophole to get drugs into the country. This reform was pushed for by both lawmakers and stakeholders for years. The STOP Act is a sensible, necessary, solution to deadly epidemic in the United.
The need for solutions like the STOP Act has been in the works since 2016 and regrettably the deadly opioid crisis has continue to spread and we still desperately need this precaution in 2021. Preliminary federal data found that 87,000 Americans died of drug overdoses over the 12-month period that ended in September. This marks the highest amount since the opioid epidemic began in the 1990s. The data shows that the coronavirus pandemic unquestionably exacerbated the trend as the largest increase in overdose deaths occurred in April and May of 2020.
It is disappointing that the Biden administration is passing up on an opportunity to keep Americans safe. While the USPS was able to increase the number of inbound international packages reporting AED to 67 percent in January of 2020, it failed to reach its goal of 100 percent of packages by the deadline imposed in the law, January 2021. Robert Cintron Vice President, Logistics United States Postal Service noted that the coronavirus pandemic impacted international mail shipments, affected their ability to do so, but as our country moves forward it is absolutely imperative that we refocus on this important issue.
The Biden Administration Should Keep America and Americans Safe by Enforcing and Upholding the Law
It is vital that we continue to advocate for these solutions as they have the potential to save lives across the country. Therefore, it is imperative for the U.S. Department of Homeland Security to go back to the drawing board on its proposed rules for collection of advance electronic information for international mail shipments, and the frameworks for collaboration between the U.S. Postal Service and the U.S. Customs and Border Protection (CBP). American citizens depend heavily on these critical safeguards for protecting our mail system. And it isn’t asking too much for the USPS to live up to similar standards of professionalism as other carriers who have been protecting parcels shipped into America for years. Moreover, the USPS shouldn’t allow itself to be used as a mule — shipping illegal and deadly drugs into America — because of its unwillingness to live up to industry standards that protect all Americans.
How many Deaths is an elected official allowed before he/she is assigned an accurate but less than complimentary Nom De Plume which reflects his/her accomplishment ? If you are Ron DeSantis of Florida the number is probably zero. However, If you are Andrew Cuomo , the number is in the thousands.
The exact number may never be known since the quality of the recordkeeping and reporting is suspect – but published reports of the effect of the his now infamous March 25, 2021 order, put the number into the thousands. For those who don’t remember, Gov. Cuomo ordered Nursing homes to accept, without testing, medically stable patients without regard as to their COVID 19 status. Nursing homes were specifically prohibited from requiring testing of a hospitalized resident determined to be medically stable.
The stated reason for this policy was the urgent need for hospital beds, yet , the Javits Center opened with a 1,000 bed capacity two days after the order was issued. The USNS Comfort , with an additional 1,000 beds arrived March 30. It left New York waters on April 30 having cared for 282 patients, less than 30% of it’s capacity. Yet the order stayed on.
The Javits center closed on May 8, 2020. The order requiring Nursing Homes to take COVID 19 positive patients remained in place until May 27, 2020 after NY had registered one of if not the highest death rate in the Nation.
Now many are suggesting that Gov. Cuomo be investigated for attempting to cover-up his handling of the news concerning his lethal order.
The time is overdue for Mr. Cuomo to receive a Nom De Plum worthy of his actions. Henceforth he shall be known as The Butcher of Albany.
Serious consideration should be given to criminal prosecution for the untold number of persons who died because of his infamous order. Their cries for justice are deafening.
The number of new COVID infections is declining rapidly, suggesting to some that the novel coronavirus pandemic may be on the verge of ending. Nevertheless, even with the advent vaccines that apparently prevent its transmission from person to person, most Americans believe the protective measures adopted over the last year like mandatory masking will continue for some time.
A recent Rasmussen Reports poll found that nearly three out of every four Americans over the age of 18 expect the requirement that masks be worn outdoors will remain in place for at least another six months. Almost a third – 36 percent – said it would be more than 18 months before it would be acceptable to be barefaced in public once again.
“It’s an indictment of the media that so many people expect mask mandates to persist for months,” said the Committee for Prosperity’s Phil Kerpen who has for months been crunching the numbers related to the pandemic and its spread.
Kerpen and his group produce a free daily hotline that provides short and timely insider updates on what is happening with the economy and the virus. It was one of the first to notice that New York’s Democratic Gov. Andrew Cuomo seemed to be fudging the numbers connected to COVID-19 in nursing homes, a story most news outlets missed.
With Vice President Kamala Harris and others inside the Biden Administration claiming, falsely, that they’ve had to begin the fight against the coronavirus “from scratch,” the recent acknowledgment by Dr. Rochelle Walensky, the director of the U.S. Centers for Disease Control and Prevention that the number of new cases and hospitalizations are indeed coming down.
“We continue to see a five-week decline in COVID cases, with cases decreasing 69 percent in the seven-day average since hitting a peak on January 11th. The current seven-day average of approximately 77,000 cases is the lowest recorded since the end of October,” Dr. Walensky said during a White House briefing Friday.
“Like new COVID-19 cases, the number of new hospital admissions continues to drop. The seven-day average of new admissions on February 16th, approximately 7,200, represents a 56 percent decline since the January 9th peak,” the doctor continued.
The problem remains what to do until what many medicos refer to as “herd immunity” is reached. Some, like Biden COVID advisor Dr. Anthony Fauci, have suggested it may be prudent to double up on masks while the CDC’s latest recommendation is “placing a sleeve made of sheer nylon hosiery material around the neck and pulling it up over either a cloth or medical procedure mask.” Others, like Kerpen, suggest the best possible thing would be for states to open up and for people to be allowed to go about their business once again, and for children to be permitted to return to school on a five-day-per-week schedule.
“More governors need to exercise the leadership of Florida’s Ron DeSantis, the Dakota’s Kristi Noem and Doug Burgum, and Kim Reynolds of Iowa and proclaim a return to normal now – now, forever, months in the future,” Kerpen said.
His suggested approach appears to be the wise one. Recent comparisons of the spread of COVID-19 in Florida and California show little difference in how things have turned out. This would seem to deflate the dire predictions Gov. DeSantis’s decision to re-open the economy in the nation’s third most populous state would push the number of infections and death off the charts.
None of that seems to have happened. What is different is that Florida’s been open for business for some time while California’s economy, which for months has been in a lockdown state, is floundering badly. The performance of the two economies, which are about as different at this point as night and day, are worth further study. There may be valuable clues regarding the best ways to fight a pandemic hidden in the data, waiting to be unmasked.
Last year, 621 people died of drug overdoses in San Francisco. To put this in perspective, 173 people died from COVID-19, which is identified as the primary public health crisis in the Bay Area.
For years, San Francisco has tacitly encouraged drug abuse with remarkably lenient policies, and those policies are now inadvertently killing hundreds of people annually. San Francisco uses a policy approach called “harm reduction,” which stresses “culturally competent, non-judgmental treatment that demonstrates respect and dignity for the individual.”
But this approach, as it is practiced within San Francisco, is inhumane and cruel. It is destroying the dignity of the lives that some could have with more sensible policies. In addition to overdose deaths skyrocketing, drug abuse has increased in San Francisco, and it is becoming more difficult for addicts to affect positive change.
If you spend much time in San Francisco, you know this, as several areas of the city have become de facto open-air drug bazaars, with drug abuse and drug sales taking place for all to see. Harm-reduction policies are expanding drug use among youths through the dispensation to homeless adolescents of “safe snorting kits” and “safe smoking kits” for crack use. As if any crack use could be considered “safe.”
There are an estimated 25,000 drug users in San Francisco, which if anything is too low of a count since that estimate is nearly two years old. This exceeds San Francisco’s high school population by more than 50 percent and works out to about 522 drug users per city block. Sadly, thousands of human tragedies unfold every day, eviscerating those who use drugs, and forever affecting the lives of those who see it daily, including many children.
Drug abuse is challenging to treat, but a recent handbook of best practices for substance abuse treatment by the Department of Health and Human Services shows that targeted treatment can be very effective, particularly when intervention occurs early.
But a drawback to San Francisco’s acceptance and facilitation of drug use is that it prevents early intervention. Unless San Francisco completely changes how it views drug abuse, these numbers will become even worse. The country’s most progressive city needs to understand that their policies are creating implicit death sentences for many who could be helped with a different policy approach.
Understanding this begins with the simple economics about drug use, which highlights why harm reduction has failed. On the demand side, drug users come to San Francisco from elsewhere because they know the city tolerates and facilitates drug use, which includes providing free hypodermic needles. While giving away nearly 5 million clean needles annually (which boils down to nearly 6 needles for every San Franciscan) admirably reduces communicable diseases, it has created a public health hazard, because about two million used needles are disposed of on city sidewalks. Over $30 million has been spent on dealing with drug abuse within the public transit system, but one could hardly tell this by viewing transit stations that anything has been done to deal with this issue.
On the supply side, selling drugs in San Francisco has become extremely profitable, given a demand side of 25,000 consumers and the city’s tolerant policies. In contrast to most other cities, the drug trade in San Francisco operates within what is almost a normal marketplace setting, where buyers and sellers can find each other easily, and with a relatively small chance of being arrested. Both of these factors promote relatively low prices, which stimulate demand, and high profits, which stimulate supply.
By normalizing drug abuse, San Francisco has created a perfect storm of a vibrant, well-functioning market of buyers and sellers who trade drugs much like a basket of fruit is traded at a farmer’s market. Unfortunately, the basket that is being traded in San Francisco’s drug bazaar is increasingly becoming the opioid Fentanyl, which can be 100 times more powerful than morphine.
Fentanyl is sufficiently strong that much less than one milligram is used as general anesthesia during major surgery. Just two milligrams—the equivalent of about 25 grains of sand—can be lethal. Emergency personnel responding to a Fentanyl overdose must take precautions so that they do not accidentally inhale Fentanyl. And yet Fentanyl is now being widely traded every day in San Francisco, driving up overdose deaths to about two daily.
What to do? Drug addiction can be treated medically and compassionately without viewing it as part of normal, everyday life, which is what is being practiced today in San Francisco. The city currently allocates over $5 billion to community health and human welfare.
Surely those budgets can be repurposed to treat drug abuse using best practices as outlined by the Department of Health and Human Services in conjunction with greater efforts to identify family members who can assist with treatment and support. At the same time, the city must reduce the amount of Fentanyl and other lethal drugs that are being sold routinely in open-air markets.
Many of San Francisco’s drug users have lost control over their lives. The last thing that drug addicts need is another drug pusher, but this is what San Francisco’s policies have created. Lives can be saved, but not unless policies are changed.
Large unexpected expenses are never welcome. No one likes a costly surprise. That may explain why Congress is talking about government imposing a “fix” to “protect” patients from surprise medical bills.
That may sound good, but healthy skepticism is warranted. One only needs to remember how the Obama-Biden administration repeatedly promised to save us all thousands of dollars every year and allow us to keep our health insurance and our doctor. None of that turned out to be true.
We need a solution to surprise medical bills that rescues consumers from being caught in between the doctor’s or hospital’s bill and the insurance company’s refusal to pay it. But we also need a solution that empowers consumers, not government bureaucrats, and that promotes innovation and harnesses the power of the marketplace to ensure high quality care at the lowest prices.
We must be 100% sure that we avoid government mandated procedures that effectively impose price controls because they also reduce the likelihood of future healthcare innovations and slow the development of promising medicines and procedures. Government mandates almost invariably shift power to government bureaucrats and health insurance companies, rather than giving consumers more control over their own healthcare.
The most common cause of a surprise medical bill is when a person uses a healthcare provider that is not in their insurance plan’s network of providers. While it doesn’t happen often, it is a real challenge for consumers when it does happen. Insurance companies have contracts with healthcare providers to provide medical services at discounted rates. That makes them “in-network.” The “out-of-network” providers charge a price without any pre-negotiated discounted rates. The problem arises when consumers get stuck between the insurance company that doesn’t want to pay and the doctor who should be paid.
The best way to solve the nation’s surprise medical bill problem is to implement a fair and open independent dispute resolution (IDR) process. A fair IDR process simply means that both sides of the out-of-network bill dispute, the physician and the health insurer, are allowed to submit all relevant information to make their case. Then the arbitrator or decision-maker can weigh the evidence and provide a fact specific resolution to what the insurance company should pay and what the doctor should accept.
This would relieve the patient of worrying about the bill, and it would make sure that difficult or complex medical procedures and treatments don’t become devalued or more difficult to find.
Sens. Lamar Alexander and Bill Cassidy are rumored to be working on a “compromise” that purports to use a form of IDR. But we should be on high alert because all indications are that the “compromise” will include a rigged or sham IDR process that puts the heavy hand of government on one side of the scales of fairness and justice. There is no reason to use a process that from the start tips the scales in favor of either the doctor or the insurance company.
This “compromise” will favor insurance companies over doctors. If the government-imposed process ends up being a price control system, it will simply be a step toward socialized medicine and will make finding doctors to treat you more difficult. What we should all want is a fair and balanced process.
A fair and impartial IDR process that resolves the pricing dispute would prevent the consumer from getting caught in the middle. It would also empower consumers, not government.
Additionally, it would harness the power of the marketplace to keep quality up and prices down. It is important to remember that government regulations don’t have a track record of reducing costs. Moreover, government mandates will do nothing to reward innovation, or to empower consumers.
Regardless of what their true motives were or are, the results we have witnessed in the last 50 years from politicians promising “fixes” has been that things end up costing a lot more than promised, and government gets more and more control. Those who can afford lobbying efforts may escape the costly impact of these government mandates. But rarely do these promised fixes on balance help the average citizen.
Instead of continuing to empower government, insurance companies, and those who can afford lobbyists to protect their interests, let’s try reforms that put economic power back in the hands of healthcare consumers. Let’s trust the marketplace to do what it does so well — boost quality and keep prices comparatively low. We trust the marketplace to provide us with food, housing, technology, and thousands of other very important things. Why not our healthcare, as well?
We can do all of this with a fair and balanced IDR process that allows both sides of the out-of-network bill dispute to submit all relevant information to make their case. If this happens, we protect consumers from surprise medical bills and we keep burdensome government mandates out of our healthcare choices. That’s a win-win!
“Saturday Night Live” is known for many things, especially the commercial spoofs that for decades have lampooned merchandise and marketing trends. One of the most iconic featured Chevy Chase as a pitchman hawking a product that was both “a dessert topping and a floor wax.”
That kind of absurd duality is funny. That kind of duality in a political group is dangerous and calls into question the advocacy in which they engage.
Everyone thinks AARP, the group formerly known as the American Association of Retired Persons, represents the interests of millions of seniors, making it one of the most powerful lobbying groups in Washington. People don’t realize it’s also an insurance company and rakes in hundreds of millions selling Medigap coverage to its members.
Which interest is dominant: the commercial or the political? Given the group’s influence on important issues like healthcare, it’s a fair question. A recently released Juniper Research Group report suggests commercial concerns now may override in importance the lifestyle and economic issues on which AARP made its name.
Citing several sources, the report says that although AARP members contacting the group’s headquarters opposed the Affordable Care Act by a margin of 14 to 1, it went ahead and backed the bill anyway. Could that be because its insurance company partner – UnitedHealth – was more interested in getting a law on the books requiring every American to purchase health insurance than what its members wanted?
The report, available at www.CommitmentToSeniors.org and compiled for the group American Commitment, says the money coming from the purchase of supplemental health insurance coverage is now AARP’s main revenue source. However, rather than helping seniors select a plan tailored to their needs or financial resources, the group sells UnitedHealth insurance exclusively in return for a 4.95% cut on every plan sold.
This relationship brought more than $600 million into AARP’s coffers in 2017. Some might see that as evidence the group has evolved into a marketing vehicle for the nation’s largest health insurer. Several ongoing lawsuits contest that the money flowing to the group from its deal with UnitedHealth constitutes an “illegal kickback” because the potential customers are told the policies are cheaper than what’s available in the marketplace when identical coverage can be obtained without paying AARP’s commission.
Many of the same politicians who criticized the health insurance industry and other corporate interests as being selfish during the debate over Obamacare nonetheless hang on every word issuing from AARP headquarters. Obviously, they’ve failed to ask themselves if the group is speaking for its members or its funders.
American needs healthcare reform. Obamacare distorted the system in all kinds of ways. It made it difficult to keep the doctors we like and to utilize the insurance we bought because deductibles have risen so much. If we’re going to have an honest discussion about how to get out of the mess we’re in, the key players need to show their cards – or have them shown for them.
The elite media and so-called good government groups keep a close eye out for conflicts of interest, both real and potential, in the advocacy community on the right.
They argue against the influence of so-called “dark money” on all kinds of issues, not just healthcare. The watchdog groups who like to tie groups that question the existence and impact of climate change to oil companies and supporters of the Second Amendment to gun manufacturers seem to have missed the link between United Health and AARP.
Maybe they just don’t want to see it.
If all you did was listen to the politicians and commentators, you’d think America’s health care system was on the verge of collapse. Nothing could be further from the truth. There are problems, but most of them have been caused by the self-same reformers who’ve been trying for more than two decades to “fix” it.
Much progress has been made since the New York Times and presidential candidate Bill Clinton declared a crisis existed and proposed solving it by increasing the role played by the government in managing the delivery of services and prices. Once the voters learned the potential adverse impacts on the quality of care they received, the debate changed.
Through it all, America has continued providing the best care anywhere. The spirit of invention and innovation that is the hallmark of our civilization exists robustly in the health care sector and, because it does, people are living longer, generally healthier lives. Yet, instead of encouraging that, scholars and policymakers continue to focus on flattening the cost curve through fiat. Price controls and rationing may reduce the perceived costs of medical care but won’t solve the problem.
The real solutions will come from innovations in care. That means continuing the development of radical new treatments that were unthinkable a generation ago and, in a few cases, going back to what was working before the government messed things up.
One place where looking back is already helping us move forward is kidney dialysis. In 1972, thinking they were helping, Congress passed legislation creating a Medicare program to pay for dialysis treatment and patients with end-stage renal disease gravitated to more expensive, center-based care using machines built for use in centers that are large, hard-to-use, and too expensive for home use.
In 1973, 40 percent of dialysis patients received treatment at home. Today, 90 percent receive treatment at dialysis centers and hospitals — at much greater cost and at greater risk to their health because the entire time they are there, checking in, checking out, waiting for and receiving treatment, they’re in the company of others who might be sick with something like COVID-19 that science tells us preys on those whose immune systems are compromised.
We spend more than $110 billion on kidney disease, the ninth leading cause of death in the United States. More than 37 million Americans have some form of this disease and the money paying for their dialysis comes from Uncle Sam through Medicare. That’s not sustainable.
The alternative to spending more is to spend smarter. The Trump Administration, which earlier this year announced a plan to “shake up” the kidney care medical complex is pushing for a return to home-based hemodialysis as a cost-saving measure and one more in line with patient concerns. His executive order on the issue included a direction to the Department of Health and Human Services to develop policies to reduce the number of Americans getting dialysis treatment at dialysis centers.
That’s the right move. The in-home care alternative will have the biggest impact in the shortest amount of time. The current care cycle, where treatment begins when it’s too late to stop disease progression. Must be broken. Instead of throwing more money at dialysis clinics, the priority is being repurposed in the right place, on early diagnosis, better patient education, and comprehensive and holistic care services.
Home-based options for hemodialysis, where blood is pumped out of the body under supervision into a machine that acts as a kidney and filters the blood before returning it to the body, and peritoneal dialysis, where blood vessels in the lining of the belly filter the blood with the help of a cleansing fluid, exist and should be utilized to the fullest extent possible.
Starting in 2021, ESRD patients will also be able to enroll in Medicare Advantage plans – great for the ESRD patients, but it could increase premiums for all seniors if we don’t help these plans negotiate for fair rates and prevent costs from rising. The Centers for Medicare and Medicaid Services should remove any roadblocks that exist to making this option viable.
With COVID-19 is changing how people go about their lives, the incentive to adapt and innovate in the health care sector is there. Telehealth, which was generally frowned upon before the current crisis, has taken off like a moonshot. Changing the kidney dialysis model to one where the care is mostly provided at home could liberate those receiving treatment now held prisoner by their illness and could lead the transformation of American medicine. Anyway, it’s worth a try.
Editor’s Note: This is an edited excerpt, comprising the Introduction and Conclusion, from a longer essay by Mr. Atlas. Titled ‘The Costs Of Regulation And Centralization In Health Care,' it is published by the Hoover Institution as part of a new initiative, "Socialism and Free-Market Capitalism: The Human Prosperity Project."
The overall goal of US health care reform is to broaden access for all Americans to high-quality medical care at lower cost. In response to a large uninsured population and increasing health care costs, the Affordable Care Act (ACA, or “Obamacare”) aimed first and foremost to increase the percentage of Americans with health insurance. It did so by broadening government insurance eligibility, adding extensive regulations and subsidies to health care delivery and payment, and imposing dozens of new taxes. The ACA was projected to spend approximately $2 trillion over the first decade on its two central components: expanding government insurance and subsidizing heavily regulated private insurance.
Through its extensive regulations on private insurance, including coverage mandates, payout requirements, co-payment limits, premium subsidies, and restrictions on medical savings accounts, the ACA counterproductively encouraged more widespread adoption of bloated insurance and furthered the construct that insurance should minimize out-of-pocket payment for all medical care. Patients in such plans do not perceive themselves as paying for these services, and neither do physicians and other providers. Because patients have little incentive to consider value, prices as well as quality indicators, such as doctor qualifications or hospital experience, remain invisible, and providers do not need to compete. The natural results are overuse of health care services and unrestrained costs.
In response to the failures of the ACA, superimposed on decades of misguided incentives in the system and the considerable health care challenges facing the country, US voters at the time of this writing are being presented with two fundamentally different visions of health care reform: (1) a single-payer, government-centralized system, including Medicare for All, the extreme model of government regulation and authority over health care and insurance, which is intended to broaden health care availability to everyone while eliminating patient concern for price; or (2) a competitive, consumer-driven system based on removing regulations that shield patients from considering price, increasing competition among providers, and empowering patients with control of the money. This model is intended to incentivize patients to consider price and value, in order to reduce the costs of medical care while enhancing its value, thereby providing broader availability of high-quality care.
Outside a discussion of the role of private versus public health insurance are two realities. First, America’s main government insurance programs, Medicare and Medicaid, are already unsustainable without reforms. The 2019 Medicare Trustees report projects that the Hospitalization Insurance Trust Fund will face depletion in 2026. Most hospitals, nursing facilities, and in-home providers lose money per Medicare patient. Dire warnings about the closure of hospitals and care provider practices are already projected by the Centers for Medicare and Medicaid due to the continued payment for services by government insurance below the cost of delivery of those services. Regardless of trust fund depletion, Medicare and Medicaid must compete with other spending in the federal budget. America’s national health expenditures now total more than $3.8 trillion per year, or 17.8 percent of gross domestic product (GDP), and they are projected to reach 19.4 percent of GDP by 2027. In 1965, at the start of Medicare, workers paying taxes for the program numbered 4.6 per beneficiary; that number will decline to 2.3 in 2030 with the aging of the baby boomer generation. Unless the current system is reformed, federal expenditures for health care and social security are projected to consume all federal revenues by 2049, eliminating the capacity for national defense, interest on the national debt, or any other domestic program.
Second, beyond the growing burden from lifestyle-induced diseases, including obesity and smoking, that will require medical care at an unprecedented level, America’s aging population means more heart disease, cancer, stroke, and dementia—diseases that depend most on specialists, complex technology, and innovative drugs for diagnosis and treatment. The current trajectory of the system is fiscally unsustainable, and millions are already excluded from the excellence of America’s medical care.
In most nations, heavy regulation of the supply of health care goods and services care is coupled with marked centralization of payment for medical care. The United States has a far less centralized but still highly regulated system in which health expenditures are roughly equal from public and private insurance. The system is characterized by its unique private components: more than 200 million Americans, including most seniors on Medicare, use private insurance. The US system is the world’s most effective by literature-based, objective measures of access, quality, and innovation, but US health care demands reform. Health care costs are high and increasing, and the projected demand for medical care by an aging population and the future burden of lifestyle-related disease threaten the sustainability of the system.
Although the regulatory expansion under the Affordable Care Act reduced the uninsured population, it generated increased private insurance premiums, a withdrawal of insurers from the market, and sector-wide consolidation that is historically associated with higher prices and reduced choices of medical care. In its wake, American voters are now presented with two fundamentally different visions for reform that have a diametrically opposed reliance on regulation and centralization: (1) the Democrats’ single-payer proposals, including Medicare-for-All, based on the most extreme level of government regulation and authority over health care and health insurance; or (2) the Trump administration’s consumer-driven system that relies on strategic deregulation to increase market-based competition among providers and empowering patients with control of the money. Both pathways are intended to contain overall expenditures on health care and broaden access.
Intuitively, a single-payer model of health care represents a simplification, but the reality is that such centralized systems impose overwhelming restrictions on both demand and supply. Government-centralized single-payer systems actively hold down health care expenditures mainly by sweeping restrictions on the utilization and payment for medical procedures, drugs, and technology under the single authority of the central government. The overall costs of this false simplification are enormous, creating societal costs that extend beyond calculated tax payments that are required to support such a system.
The alternative approach involves rule elimination and decentralization, that is, strategic deregulation, to induce competition for value-seeking patients. Reducing the price of health care by competition, instead of more regulation, generates lower insurance premiums, reduces outlays from government programs, and broadens access to quality care. Broadly available options for cheaper, high-deductible coverage less burdened by regulations; markedly expanded health savings accounts; and tax reforms to unleash consumer power are keys to achieving price sensitivity for health care. Reforms to increase the supply of medical care by breaking down long-standing anti-consumer barriers to competition, such as archaic certificates‐of‐need for technology, unnecessary state‐based licensure of physicians, and overly regulated pathways to drug development, while facilitating transparency of price and quality among doctors and hospitals, would generate further competition and reduce the price of health care. Preliminary results from such deregulatory actions demonstrate promising results and offer an evidence-based context for the broader discussion of the role and reach of government regulation in socialism compared with free-market systems.
A lot to argue about!
Trump held his first post-lockdown rally last evening in Tulsa, Oklahoma. There was controversy before, during and after the event. Criticism was not confined to the content of the speech as usual but spread over the unusual areas of the timing, location, venue, and attendance of the rally.
The earliest criticism concerned the timing of the event. A Trump rally, held in an indoor arena, was criticized as a blatant violation of the CDC current (and often changing) recommendations regarding safeguards against the “Chinese virus”, as Trump calls it. Among the most obvious violations were the lack of social distancing in the densely packed house, without compulsory masks, and held indoors (as opposed to outdoors).
After the rally, much was made of the lower attendance. Not only were there noticeable empty bleachers (which the network cameras showed frequently), but also the scheduled outdoor appearance by the President was cancelled because the only crowd out there was the ever-present (thankfully peaceful) protesters. Nevertheless, there were approximately 18,000 or more in attendance, counting the seating on the floor of the arena, out of a published capacity of 19,000. One unaccounted-for factor was the absence of the 0ver-65 crowd who tend to be among the most loyal of the Trump base.
So, what to think about all this? First of all, there is the symbolic significance of the scheduling. The President has shown in various ways that the public health contingent – which essentially scared him (and all of us) into the lock-down in the first place – is no longer calling the shots in the White House response to the pandemic.
This column remarked very early in the process the fact that the public health perspective is necessarily limited. Never before in American history has this group been given such control over public policy. At the first sign of a public health threat, Mr. Trump, in typical CEO practice, called into service the finest experts he could find in this field – which he admitted was far from his own experience. He then followed their advice, quite uncritically. As I pointed out at the time, this was a huge gamble: if it went wrong, it could, among other things, cost him the election and even his place in history. (See https://drlarryonline.com/trumps-huge-gamble/)
After a while, he did begin to appreciate the narrowness of that perspective. But he was stuck in the middle of a lock-down which he had ordered! Thus, began the journey back to recovery, to normalcy. His diffusion of power to local politicians was a stroke of genius. Not only did he gradually shed the sole responsibility for the lock-down, but he made friends and evoked loyalties among an entire new group of politicians with whom he had had little prior contact. And it was acting out the essence of the Constitution, which sees the sovereign states as surrendering and thereby validating some of their powers to create the federal government.
This entire scenario was moving along quite nicely. Then two unexpected things happened: the Washington Democrats in Congress began to “adopt” the public health establishment, endorsing ever more stringent limitations on the population in the name of the pandemic. As this attitude began to percolate out to the state governors, the recovery slowed down.
By this time Trump and his people had fully realized that the lock-down had nearly ruined the economy and still threatened to do so. They went into overdrive to speed up the recovery. Trump was still winning, however, until the next shoe dropped: a cellphone video of the brutal murder of a defenseless Black man by a White policeman in Minneapolis went viral on social media. The reaction was a worldwide protest against civil authority in America. After a few peaceful marches, the movement turned violent and radical leadership emerged.
Among other secondary effects, the total attention of America — and much of the world – turned away from the economic recovery and toward the protesters and the rioters.
Some past events of this type have elicited soaring rhetoric from leaders such as the Reverend Martin Luther King, Jr. and Senator Robert Kennedy to begin healing the wounds. Soaring rhetoric is not one of Mr. Trump’s talents. Nor does he have the soothing, compassionate manner of a Bill Clinton or a George Bush. In the face of these disasters, Donald Trump stumbled.
The Democrat opposition immediately made him the face of the disaster. His poll numbers have tumbled, yielding to the reclusive Mr. Biden whose silence has served him well.
Trump may not be a great orator or an instinctive healer, but he does excel at one thing: he can draw thousands of impassioned participants to his rallies. This is his unique sandbox and he felt the urgency to activate it.
The Tulsa Rally was the first step on Trump’s road to recovery. It was an act of defiance to the public health establishment and their new sponsors, the Democrats and the press. It also emphasizes the simple truth that the virus is going to be around for a long time, and we have to learn to live with it while carrying on our normal economic activity. Our financial survival as a nation depends on it.
Whether Trump’s new strategy succeeds or not depends on the next steps. In one of Mr. Trump’s favorite sayings, “We’ll see what happens.”
Indeed, we will.
Unexpected expenses are never welcome and no one likes a costly surprise. So it’s no wonder that there is a lot of talk in Washington and Congress about “protecting” patients from surprise medical bills. Current legislation — SB 1895 — sponsored by Senators Lamar Alexander (R-Tenn) and Patty Murray (D-Wash.) makes such claims. It sounds good until you realize that all the “protecting” talk is just that — talk. Even worse, is that rather than protecting consumers, it will make things worse.
The most common cause of a surprise medical bill is when a person uses a healthcare provider that is not in their insurance plan’s network of providers. While it doesn’t happen that often, it most typically happens in a hospital emergency room — either because the patient is not able to consent to care or because the patient received inaccurate information about insurance coverage.
Insurance companies have contracts with healthcare providers (both doctors and hospitals) to provide medical services at pre-negotiated discounted rates. That makes them “in-network.” The “out-of-network” providers charge a price without any pre-negotiated discounted rates, meaning the out of network costs are greater.
While it is true that most doctors are in most insurance networks and hospitals often have ways to shield their patients from higher costs, there are occasional gaps that remain. And while it is uncommon, it can be costly when it occurs. But despite their rarity, these circumstances are used by politicians to make us think they are proactively solving problems for our benefit. Sadly, they are doing nothing of the sort.
There are a number of proposals currently under consideration in the halls of Congress to fix surprise billing, but they have a couple important things in common. In one-way or another, all of these pieces of legislation entrust the government with the power to set prices. This will impose heavy costs even if executed properly, an idea that is almost laughable given the government’s track record on reducing costs.
This reminds me of the Obama-Biden repeated promise that they had a plan that would save us all thousands of dollars every year and allow us to keep our healthcare plan if that’s what we wanted. Obviously, Obama and Biden failed to deliver on that promise. It was the lie of the year even as judged by liberal fact checkers. Literally, millions of Americans lost their preferred plans and virtually everyone saw their health insurance costs increase, not decrease, by thousands.
So a healthy dose of skepticism about promises to fix surprise billing with government price controls is entirely justified. It should not be enough for politicians to repeat over and over the mantra that they’ve got the fix. We’ve seen this play before. It doesn’t end well.
Government-imposed price controls skew incentives and reduce the availability of quality healthcare. To make things worse, government-imposed price controls also reduce the likelihood of future healthcare innovations and slow the development of promising medicines and procedures. But the bad news doesn’t end there — current proposals shift more and more power to health insurance companies, rather than giving consumers more control over their own healthcare.
Regardless of what their true motives were or are, the results we have witnessed in the last 50 years from politicians promising “fixes” has been that things end up costing a lot more than promised, and government gets more and more control. Those who can afford lobbying efforts may escape the costly impact of these government mandates. But rarely do these promised fixes on balance help the average citizen.
The marketplace — and the negotiations that take place when you have two or more parties all trying to maximize the value that they receive — has a knack for providing high quality goods and services for the lowest possible prices. That is the process that has brought us smart phones that have more computing power than was used in the 1960s in the Apollo program. It’s also the process that allows consumers to own huge flat screen televisions at a cost of several hundred dollars. We need to harness that power and that drive to high quality and low prices in the medical arena.
Instead of continuing to empower government and those who can afford lobbyists to protect their interests, let’s try reforms that put economic power back in the hands of healthcare consumers. Let’s trust the marketplace to do what it does so well — boost quality and keep prices comparatively low. We trust the marketplace to provide us with food, housing, technology, and a thousand other things, why not our healthcare as well?
Today, the average American eats better and spends a lot less to feed themselves than our great grandparents did. As a result, we have access to all manner of foods — something even kings didn’t have a few generations ago. Additionally, we work far fewer hours to obtain that food. As a result, we have more money for larger, more comfortable homes, nice automobiles, vacations, and hospitals — something average Americans in 1776 didn’t even dream about.
So if we want to see more affordable and better quality healthcare available to us all — why not harness the power of the marketplace? Where’s the proof that government-run schemes produce the needed quality and low costs? In contrast, the marketplace has a strong track record. Let’s try it!
Liberals and conservatives are approaching the COVID-19 pandemic through very different moral frameworks.
In a 2008 TED Talk, psychologist Jonathan Haidt said the worst idea in psychology is the notion that humans are born as a “blank slate.”
Like the cognitive psychologist Steven Pinker, Haidt was rejecting the notion that the human mind is a blank slate at birth, an idea that can be traced to thinkers from Aristotle, to John Locke, to B.F. Skinner and beyond.
“Developmental psychology has shown that kids come into the world already knowing so much about the physical and social worlds and programmed to make it really easy for them to learn certain things and hard to learn others,” explained Haidt, a Professor of Ethical Leadership at NYU’s Stern School of Business.
Citing research from the brain scientist Gary Marcus, Haidt said the initial organization of the brain essentially comes with a “first draft.” Studying the anthropological and historical records, Haidt found that five pillars of morality exist across disciplines, cultures, and even species:
What’s interesting is that these moral pillars differ sharply across ideological lines in America today. Haidt found that both conservatives and liberals recognize the harm/care and fairness/reciprocity values (though liberals value these a little more than conservatives). Things change, however, when examining the three remaining foundational values—loyalty/betrayal, authority/subversion, and sanctity/degradation. While conservatives accept these moral values, liberal-minded people tend to reject them.
The difference is extraordinary, and it helps explain the different ways Republicans and Democrats are experiencing the coronavirus. In May, a CNBC/Change Research survey found that while only 39 percent of Republicans said they had serious concerns about COVID-19, 97 percent of Democrats said they had serious concerns.
While some of the divergence could stem from the fact that blue states have been hit harder by COVID-19 than red states, Haidt’s research would suggest that another reason Democrats are more concerned is because liberals have an intense appreciation of the care/harm moral pillar.
Indeed, the preeminence of the care/harm moral can be found in the rhetoric of many progressives.
“I want to be able to say to the people of New York, ‘I did everything we could do,’” New York Gov. Andrew Cuomo announced in March. “And if everything we do saves just one life, I’ll be happy.”
The care/harm moral is even found in the latest social media emojis. Last month, as USA Today reported in an exclusive story, Facebook rolled out its new “care” emoji.
“The new Facebook reaction—an emoji hugging a heart—is intended as shorthand to show caring and solidarity when commenting on a status update, message, photo or video during the coronavirus crisis that allow users to express how much they care about others,” the paper reported.
Cuomo’s language (and to a lesser extent Facebook’s emojis) suggests that, for many, care for others is the preeminent virtue. As such, efforts to protect people must be taken above lesser social considerations.
Understanding the different moral framework conservatives and liberals are using helps us understand why blue states have taken a much more aggressive approach in efforts to limit the spread of COVID-19.
As The Atlantic explains, with a few exceptions, such as Ohio, Republican governors have been much more reluctant to impose sweeping restrictions on their residents than states led by Democratic governors. While governors in these states no doubt value care/harm, their moral framework likely gives them a heightened concern of other social considerations, particularly civil liberties.
The lockdowns, the Constitution Center explains, have threatened many of America’s most cherished civil liberties—the freedom to assemble, the right to purchase a firearm, the ability to freely travel, the freedom to attend church or visit a reproductive health facility. They’ve also put thousands of companies on a path toward bankruptcy by prohibiting them from engaging in commerce.
These infringements tend to be viewed as reasonable to liberals, who emphasize the care/harm moral but are less likely to recognize the sanctity/degradation moral. New Jersey Gov. Phil Murphy, for example, said he never even considered the US Constitution—a document considered sacrosanct by many Americans—when he issued his lockdown order.
“That’s above my pay grade,” Murphy told Tucker Carlson in April. “I wasn’t thinking of the Bill of Rights when we did this. We went to all—first of all—we went to the scientists who said people have to stay away from each other.”
Similarly, Michigan Gov. Gretchen Whitmer saw no problem in suspending the Freedom of Information Act to prevent outside groups from assessing the model state officials used to justify locking down the entire state.
Those who view civil liberties and constitutional rights as sacred, however, are less than comfortable with such an approach. They will be less inclined to sacrifice sacred principles to support sweeping state efforts to protect people (and are probably more likely to see such efforts as counter-productive).
To be sure, some progressives do see civil liberties as sacred, and some of them have expressed dismay and bewilderment that so many progressives, in their enthusiasm for the care/harm moral, have abandoned civil liberties.
“[The COVID-19 crisis is] raising serious civil liberties issues, from prisoners trapped in deadly conditions to profound questions about speech and assembly, the limits to surveillance and snitching, etc.,” the progressive journalist Matt Taibbi recently wrote in Rolling Stone. “If this disease is going to be in our lives for the foreseeable future, that makes it more urgent that we talk about what these rules will be, not less—yet the party I grew up supporting seems to have lost the ability to do so, and I don’t understand why.”
If Haidt’s theory is correct, the reason is liberals and conservatives are, generally speaking, approaching the COVID-19 pandemic through divergent moral frameworks.
After all, the argument isn’t whether we should protect people.
“In any country, the disagreement isn’t over harm and fairness,” Haidt says. “Everyone agrees that harm and fairness matter.”
The argument isn’t even over how to best balance the care/harm moral with other considerations.
The disagreement is over whether efforts to protect individuals from COVID-19 should be balanced against other considerations—including constitutional and economic ones—at all.